BackgroundThe establishment of therapeutic regimens for mycobacteriosis depends on the accurate identification of Mycobacterium species, and misdiagnosis can result in inappropriate treatment and increased mortality of patients. Differential diagnosis among Mycobacterium species has been made by conventional phenotypic and biochemical tests after a long culture period. Specialized molecular diagnostics of mycobacteria allows rapid detection and species identification; however, such tests are not available in public health programs. Our aim was to demonstrate the clinical implications of erroneous diagnosis by performing molecular genotyping of mycobacterial infections in patients that were diagnosed based on symptoms, culture and bacilloscopy.MethodsCulture samples of mycobacterial infections from 55 patients clinically diagnosed as tuberculosis in 2013 and 2014, based on conventional methods, were identified by PCR -RFLP and results are discussed.ResultsWe have confirmed 35 (63.6 %) positive samples as M. tuberculosis, but 18 (32.7 %) were identified as non-tuberculous mycobacteria (M. avium type 1, M. avium type 2, M. kansasii type 1 type 1, M. mucogenicum, M. chelonae, M. terrae type 3, and 1 unknown RFLP pattern) and two were negative. Regarding clinical diagnosis, 61.8 % (34/55) was classified as pulmonary tuberculosis. It is important to emphasize that 36.4 % (20/55) of samples were misdiagnosed by conventional methods, and 11 (61.1 %) of the HIV positive patients (18/55) were NTM-coinfected.ConclusionThe identification of species in mycobacterial infections is essential for correct diagnosis and choice of treatment regimen, and misdiagnosis by conventional tools can lead to chronic disease, increased resistance and death.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1474-6) contains supplementary material, which is available to authorized users.
The synthesis and engineering of nanomaterials offer more robust systems for the treatment of cancer, with technologies that combine therapy with imaging diagnostic tools in the so-called nanotheranostics. Among the most studied systems, there are quantum dots, liposomes, polymeric nanoparticles, inorganic nanoparticles, magnetic nanoparticles, dendrimers, and gold nanoparticles. Most of the advantages of nanomaterials over the classic anticancer therapies come from their optimal size, which prevents the elimination by the kidneys and enhances their permeation in the tumor due to the abnormal blood vessels present in cancer tissues. Furthermore, the drug delivery and the contrast efficiency for imaging are enhanced, especially due to the increased surface area and the selective accumulation in the desired tissues. This property leads to the reduced drug dose necessary to exert the desired effect and for a longer action within the tumor. Finally, they are made so that there is no degradation into toxic byproducts and have a lower immune response triggering. In this article, we intend to review and discuss the state-of-the-art regarding the use of nanomaterials as therapeutic and diagnostic tools for lung, breast, and prostate cancer, as they are among the most prevalent worldwide.
Introdução: O estabelecimento do regime terapêutico para micobacterioses depende da identificação precisa da espécie de micobactéria, sendo que a falha no diagnóstico pode resultar em tratamento inadequado e aumento da taxa de mortalidade dos pacientes. A diferenciação entre espécies de micobactérias tem sido feita por meio de testes convencionais que analisam características fenotípicas e bioquímicas após um longo período de cultura. O diagnóstico molecular de micobactérias permite a rápida detecção e identificação das espécies, embora não esteja disponível nos programas de saúde pública. Objetivo: Padronizar o uso da técnica molecular PCR-RFLP hsp65 na identificação de espécies de micobactérias, testar esse método em amostras de cultura de pacientes diagnosticados com micobacterioses, comparando com as técnicas convencionais e determinar as implicações clínicas do da falha no diagnóstico baseado na sintomatologia, cultura e baciloscopia. Metodologia: A técnica de PCR-RFLP hsp65 foi padronizada em amostras já identificadas em centros de referência e posteriormente testadas em 55 amostras de cultura provenientes de pacientes com micobacterioses ocorridas em 2013 e 2014, comparando os resultados com o diagnóstico clínico. Resultados: Todos os pacientes foram diagnosticados por método convencional como tuberculose, mas apenas 63,7% (35/55) das amostras de cultura foram confirmadas como M. tuberculosis pela PCR-RFLP e o restante, 36,3% (20/55) dos pacientes foram diagnosticados por método molecular como micobactérias atípicas. A PCR-RFLP hsp65 identificou 32,7% (18/55) amostras positivas para micobactérias não tuberculosas (M avium tipo 1, M. avium tipo 2, M. kansasii tipo 1, M. intracellulare tipo 1, M. mucogenicum, M. chelonae, M. terrae tipo 3 e uma sem padrão conhecido na literatura) e 3,7% (2 amostras) foram negativas. Quanto ao tratamento, apenas 11% (6/55) tiveram tratamento substitutivo no caso de falha do tratamento padrão e suspeita ou confirmação de infecção por micobactéria atípica. Conclusão: A PCR-RFLPhsp65 diferenciou o complexo tuberculose das micobactérias não-tuberculosas classificando-as em nível de espécie, demonstrando ser discriminatório, rápido e econômico. A identificação da espécie em infecções micobacterianas é imprescindível para a escolha do esquema terapêutico correto e o uso dessa técnica poderá auxiliar os programas de saúde pública aumentando a precisão nos diagnósticos e diminuindo os tratamentos inadequados.Palavras-chave: Micobacterias. PCR-RFLP. Diagnóstico Molecular.
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